Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-3315
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
4230 W UNION HILLS DR, GLENDALE, AZ 85308-1704
(623) 869-7928
(623) 869-7991
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 258-6724
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
Y004199
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1991878
PK
—
05
—
914681
—
AZ
Enumeration date
07/17/2006
Last updated
06/19/2025
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